Archived: Heathcotes (Park View)

Heathcotes (Park View) is a residential care home providing personal care for up to five people in one building. It specialises in supporting people who have learning disabilities and or autism. At the time of our inspection, there were three people living at the home.

The home has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who live in the home can live as full a life as possible and achieve the best possible outcomes.

The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People living in the home receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People received safe care and felt safe in the service. Staff we spoke with understood safeguarding procedures and felt confident their concerns would be listened to and followed up.

Relatives we spoke with told us they felt their family members were safely supported. Risk assessments were in place to manage risks in people's lives.

Infection control measures had been increased since Covid-19 and the CQC had signposted the manager towards updated guidance for Personal Protective Equipment (PPE) in Care Homes for their staff.

Staff recruitment procedures ensured appropriate pre-employment checks were carried out. Staffing levels were sufficient and consistent within the home, and people got prompt support they needed from staff.

Medicines were stored and administered safely, and staff were trained to support people effectively. Staff were supervised well and felt confident in their roles and supported by the management team.

Audits of the service were clear and any issues found were addressed promptly. Staff were motivated to provide good care to people, despite Covid 19 having a big effect on everyone.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 11 May 2019).

Why we inspected

We undertook this focused inspection as this service was identified at risk of being a closed culture. A closed culture is a poor culture in a health or care service that increases the risk of harm. This includes abuse and human rights breaches. The development of closed cultures can be deliberate or unintentional – either way it can cause unacceptable harm to a person and their loved ones. A decision was made for us to inspect and examine those risks. This report only covers our findings in relation to the Key Questions Safe and Well-led, which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-led sections of the report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heathcotes (Park View) on our website at www.cqc.org.uk.

The home has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who live in the home can live as full a life as possible and achieve the best possible outcomes.

The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People living in the home receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

People were unable to verbally communicate with us during the inspection, so we observed care.

The environment did not always meet people’s needs or support their independence. The provider’s staff shifts had not always allowed staff to take scheduled breaks.

People's relatives told us they thought their relative was safe at the home. Staff at the home knew people's individual risks, however some improvements were needed in relation to staff evidencing their understanding and their implementation of these. Environmental risk management and infection control procedures were sufficient.

All staff had received induction and mandatory training. Training had been refreshed at the timescales identified by the provider.

Safe recruitment procedures were followed, however the recruitment rationale for recruiting staff with little or no experience of working with people with complex needs had not been evidenced.

People were supported to eat a balanced diet that met their needs and any associated risks were managed with appropriate specialist input. Staff worked effectively with community health and social care professionals to achieve positive outcomes for people and ensured their health needs were met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interest. Policies and systems were in place and staff practice did follow policy in relation to the recording of mental capacity assessments and administration of Deprivation of Liberty safeguards (DoLS).

Staff knew the people they supported well and adopted a caring approach towards their work. People were treated with dignity and respect. People's care plans were individual to them, covered key aspects of their care needs and promoted a person-centred approach.

People had support to participate in some social and recreational activities. People and their relatives understood how to raise any concerns or complaints with the provider.

The management team promoted effective engagement with people and their relatives. Staff felt supported. People were encouraged to express their views about the care provided, and these were listened to.

Quality assurance systems and processes were now in place, driving improvements, although improvements needed to be sustained, to ensure these are fully embedded into staff’s daily practice. Organisational oversight of the home’s environment needed to improve, to ensure it met people’s needs.

Rating at last inspection

The last rating for this service was requires improvement (published 17 April 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of these regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the home until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

The service has been developed and designed in line with the values that underpin the 'Registering the Right Support' and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

• A lack of leadership and management in the service had affected the quality and safety of the care provided.

• Audits were not always effective in identifying where improvements were needed.

• Timely action was not always taken to respond to known areas of required improvement.

• Sufficient numbers of staff were not consistently deployed to support people safely.

• People’s safety was not always maintained because staff did not always follow the risk management plans in place to mitigate risks to people.

• People had not been consistently safeguarded from abuse; this was being investigated by the local authority. Action had been taken to ensure that people’s support was provided in a safe appropriate way.

• Improvements were required to medicines record keeping. People received their medicines as prescribed.

• The environment was not consistently maintained to a safe standard. The arrangements in place for infection control required improvement.

• People’s needs had not consistently been met by staff who acted with appropriate knowledge and skills when providing their support. Action was ongoing to improve staff knowledge and skills.

• People’s personal information was not stored securely.

• Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

• Staff were supervised well and felt supported by the manager.

• People were supported to have a varied diet.

• Healthcare needs were met, and people had access to health professionals as required.

• People's consent was gained before any care was provided.

• Staff treated people with kindness, dignity and respect and spent time getting to know them.

• Systems had been reviewed to ensure that people were supported in the least restrictive way possible.

• Care plans reflected people’s likes, dislikes and preferences.

• People’s access to activities to enhance their emotional wellbeing and independence had been affected by low staffing levels. This had been recognised and action taken to improve people’s access to activity.

• People and their family were involved in their own care planning as much as was possible.

• A complaints system was in place and was used effectively.

• The manager was open and honest, and worked in partnership with outside agencies to improve people’s support where required. People, relatives and staff told us that the manager had made positive improvements at the service.

•The service met the characteristics of ‘requires improvement’ in four key questions we inspected. Therefore, the overall rating for the service after this inspection was ‘requires improvement’.

More information is in the full report.

Rating at last inspection:

Requires Improvement (report published 13 March 2018)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

At the last comprehensive inspection, we found that the service was not always safe or well led. The provider was in breach of regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Premises and equipment. We asked the provider to make improvements in relation to the safety of the service. The provider submitted an action plan detailing the improvements that they had made to comply with the regulations. They stated that they were compliant by 1 April 2018. We checked that they had taken sufficient action to comply with the regulation and found that they had. This is the second time the service has been rated requires improvement.

Prior to this inspection we were aware of ongoing investigations by the safeguarding team into allegations of physical abuse and neglect. We were also aware that the provider had an action plan in place from the local authority quality improvement team and was receiving regular support visits from the quality improvement officer.

Enforcement:

At this inspection we found the provider to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Action we told provider to take is recorded at the end of the report.

Follow up:

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Heathcotes Parkview is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Heathcotes Parkview is registered to accommodate up to five people. The service supports people with autism and a learning disability. The service is a bungalow with five bedrooms and communal living areas, in a residential area in Wellingborough. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. At the time of our inspection, 5 people were receiving care.

The service was not always safe. We found that two bedrooms had mould growing on the ceiling and a damp smell. This was caused by water coming in to the building from the outside. Action was not taken promptly to resolve this issue, and make sure people could sleep in completely clean, damp free bedrooms. We found the service to be in breach of one regulation. You can see what action we told the provider to take at the back of the full version of the report.

All other areas of the service were clean and tidy. Staff were trained in infection control, and told us they had the appropriate personal protective equipment to perform their roles safely. Regular cleaning took place to ensure the prevention of the spread of infection.

Quality monitoring systems and processes were in place and comprehensive audits were taking place within the service to identify where improvements could be made. These audits were not always effective, as actions were not always taken to make necessary and prompt improvements.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe, and staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse. People had risk assessments in place to cover any risks that were present within their lives, but also enable them to be as independent as possible. All the staff we spoke with were confident that any concerns they raised would be followed up appropriately by the registered manager.

Staffing levels were adequate to meet people's current needs, and rotas showed that staffing was consistent.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. References and security checks were carried out as required.

Staff attended induction training where they completed mandatory training courses and were able to shadow more experienced staff giving care. Staff told us that they were able to update their mandatory training with short refresher courses.

Staff supported people with the administration of medicines, and were trained to do so. The people we spoke with were happy with the support they received.

Staff were well supported by the registered manager and senior team, and had one to one supervisions and observations.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met. Consent forms were signed and within people’s files.

People were able to choose the food and drink they wanted and staff supported people with this. People could be supported to access health appointments when necessary. Health professionals were involved with people’s support as and when required.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. People told us they were happy with the way that staff spoke to them, and they provided their care in a respectful and dignified manner.

People were involved in their own care planning as much as they could be, and were able to contribute to the way in which they were supported. Care planning was personalised and mentioned people’s likes and dislikes, so that staff understood their needs fully. People told us they felt in control of their care and were listened to by staff.

The service had a complaints procedure in place. This ensured people and their families were able to provide feedback about their care and to help the service make improvements where required. The people we spoke with knew how to use it.

The service worked in partnership with other agencies to ensure quality of care across all levels. Communication was open and honest, and improvements were highlighted and worked upon as required.